OSTEOPOROSIS Prepared By Dr. MOHSEN A. GHAFFAR Consultant

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OSTEOPOROSIS

• Prepared By
• Dr. MOHSEN A. GHAFFAR
• Consultant Orthopaedic Surgery
• Al Jedaani Group Of Hospitals

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Bone Composition

• Inorganic Matter
• Mineral forms approximately 70 of bone mass
  .
• About 95 of mineral phase is calcium
  hydroxyapatite, the
• remaining 5 bone apatite impurities
  containing carbonate
• in high concentration and small amount of
  magnesium,sod-
• ium, potasium, strontium , flouride and
  chloride .
• Organic Matter
• This forms 30 of bone mass .
• It is formed of water(5-8) and organic
  matrix .
• Organic matrix is formed of collagen and
  non-collagenous proteins (98) and bone cells
  (2) .

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Bone Cells

• Osteoblast This is responsible for bone
  formation ,and
• Control of bone
  metabolism .
• Osteocyte This the mature bone cell ,
  responsible for
• nutrition of bone and
  ion exchange between
• bone and blood .
• Osteoclast This is the active agent in bone
  resorption
• and resposible for
  bone remodeling .

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Bone Modeling and Remodeling

• Two distinct processes are responsible for the
  architecture of bone , modeling and remodeling .
• ModelingThis is a process of coordinated bone
  formation and resorption with change in the shape
  of bone like what happens during growth of bone
  in childhood and in case of callus formation
  during healing of fractures .
• Remodeling This is a coupled process of bone
  formation and bone resorption which occur
  simultaneously without change in the shape of
  bone.The idea is to renew the bone continuously
  to withstand the new stresses applied on it ,
  and to maintain the bone mass .
• Bone modeling and remodeling occur through out
  life,with positive balance towards bone formation
  in young age and towards bone resorption in old
  age (Osteoporosis ) .

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DIFINITIONS

• OSTEOPOROSIS
  
• Deficiency in both organic and inorganic
  elements of bone , this happens when the rate of
  bone resorption exceeds rate of bone formation.
• OSTEOMALACIA
• Deficiency in the inorganic element only
  ,i.e defective
• mineralization , i.e abnormal bone tissue .
• OSTEOPENIA refer to loss of bone mass, which is
  the amount of bone tissue per unit volume of bone
  .
• Osteopenia is a normal feature of ageing, so
  within certain limits it is a physiological
  process . Beyond these limits the condition is
  pathological and progress to osteoporosis or
  osteomalacia .

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OSTEOPOROSIS

• Osteoporosis is the most common skeletal disorder
  in the world .
• Both sexes are affected as they age, but women
  are more susceptible .
• It is genetically related .
• Racial variation is known .

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Causes Of Osteoporosis

• Primary (Idiopathic or Involutional)
• - Type-1(Postmenopausal) It occurs in women
  after menopause . Estrogen deficiency plays a
  primary
• role It is associated with vertebral crush
  and distal radius fractures .
• - Type-2(Senile) occurs in men and women over
  
• the age of 70, female to male ratio 2 1
• Secondary Associated with other pathological
  conditions like endocrinal disorders, drug
  therapy, hematologic disorder, mechanical
  disorder , metabolic collagen disturbance or
  nutritional disorder .

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Causes Of Secondary Osteoporosis

• Endocrinal
• Cushing syndrome ,thyrotoxicosis ,
  hyperparathyroidism , hypogonadism , diabetes
  mellitus .
• Drug therapy
• Glucocorticoids,thyroxine,heparin,
  diuretics,cytotoxic drugs
• Mechanical
• Fracture immobilisation, bed rest , sedentary
  life , paralysis
• Nutritional
• Malabsorption, chronic liver disease ,organ
  transplantation
• Haematological
• Sickle cell anaemia , thalassemia
• Neoplastic
• Leukaemia , multiple myeloma
• Collagen disorders
• Osteogenesis imperfecta , homocystinuria

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Diagnosis

• Osteoporosis is a silent and progressive
  disorder .
• It is discovered only accidentally during
  routine check
• up or after X-Ray in cases of trauma .
• Components of diagnosis are
• History
• Complete clinical examination
• Radiographic diagnosis
• Bone Density(Mass) Measurement
• Biochemical Tests
• Bone Biopsy( Histomorphometry)

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History

• - Complaint pain diffuse or localized with or
  without trauma
• - Associated Symptoms malaise,loss of weight or
  height,hot
• flushes,neck swelling, palpitation
  ,epigastric pain ,disturbed
• bowel habits,renal pain,dysuria,joint
  pain,psychiatric upsets
• - Menstrual History amenorrhoea (menopause ,
  pregnancy , lactation )
• - Medications glucocorticoids, thyroxine ,
  anti-coagulant , anti-metabolites, antiacids ,
  contraceptives
• - Dietary History daily intake of milk,
  protein, indigestion.
• - Life style, sedentary life, smoking, alcohol .
• - Family History .

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Radiographic Diagnosis

• A) Spine
• - Radiolucency is increased in the center of
  vertebral body
• - Trabecular pattern is changed Thin and
  sparse trabeculae some trabeculae are lost ,
  porosity and thinning of the cortex
• - Shape is changed (Deformity) Wedge ,
  Biconcavity or Compression
• B) Proximal Femur
• Trabecular pattern is altered ,thin cortex,
  pathological
• fracture
• C) Tubular Bone
• Diffuse thinning of the cortex, subperiosteal
  erosions , radiolucent areas or striations

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BONE DENSITY MEASUREMENT(BONE DENSITOMETRY)

• Indications
• - To diagnose current osteoporosis
• - To establish future fracture risk
• - To monitor effect of treatment
• Techniques
• - Single photon absorptiometry SPA
• - Dual photon absorptiometry DPA
• - Dual X-ray absorptiometry DXA
• - Quantitative computed tomography QCT
• - Quantitative ultrasound measurement QUS

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LABORATORY TESTS

• No specific biochemical profile for
  primary osteoporosis . The diagnostic importance
  of laboratory tests is to explore causes of
  secondary osteoporosis .
• Routine tests complete blood count,electrolytes,c
  reatinine, blood urea nitrogen, calcium,
  phosphorus, protein ,albumin, alkaline
  phosphatase , liver enzymes .
• Special tests
• - Parathyroid function test
• - Vitamin D metabolites
• - Adrenal function tests
• - Tests for malabsorbtion
• - Biochemical markers of bone turnover

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BONE BIOPSY(HISTOMORPHOMETRY)

• Uses
• - Evaluation of the rate of bone turnover in
  case of unusual
• forms of osteoporosis(young adult, idopathic
  osteoporosis)
• - To exclude other forms of bone disease ,if
  the diagnosis is
• not sure
• Technique
• - Static histomorphometry
• - Dynamic histomorphometry

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Thank you